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Z Orthop Unfall 2023; 161(02): 143-153
DOI: 10.1055/a-1498-2975
Review/Übersicht

Current Minimally Invasive Surgical Concepts for Sacral Insufficiency Fractures

Article in several languages: English | deutsch
Ulrich Josef Albert Spiegl 
1   Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Leipzig, Germany
,
Klaus J. Schnake
2   Zentrum für Wirbelsäulen- und Skoliosetherapie, Malteser Waldkrankenhaus St Marien gGmbH, Erlangen, Germany
3   Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität Klinikum Nürnberg, Nürnberg
,
Bernhard Ullrich
4   Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Germany
,
Max J. Scheyerer 
5   Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinik Köln, Germany
,
Georg Osterhoff
1   Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Leipzig, Germany
,
Holger Siekmann
6   Unfallchirurgie, AMEOS Klinikum Sankt Salvator Halberstadt GmbH, Germany
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Abstract

An increasing incidence of sacral insufficiency fractures in geriatric patients has been documented, representing a major challenge to our healthcare system. Determining the accurate diagnosis requires the use of sectional imaging, including computed tomography and magnetic resonance imaging. Initially, non-surgical treatment is indicated for the majority of patients. If non-surgical treatment fails, several minimally invasive therapeutic strategies can be used, which have shown promising results in small case series. These approaches are sacroplasty, percutaneous iliosacral screw fixation (S1 with or without S2), trans-sacral screw fixation or implantation of a trans-sacral bar, transiliac internal fixator stabilisation, and spinopelvic stabilisation. These surgical strategies and their indications are reported in detail. Generally, treatment-related decision making depends on the clinical presentation, fracture morphology, and attending surgeonʼs experience.

Key words

posterior pelvis - sacral fracture - minimally invasive stabilization - insufficiency fracture - fragility


Publication History

Article published online:
27 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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